Preterm Labor & Birth

Background

A normal pregnancy is 9 months or 40 weeks long. A woman's due date is the date she completes 40 weeks of pregnancy since the first day of her last menstrual period. That amount of time gives the baby the best chance to be healthy. A pregnancy that ends between 20 weeks and 37 weeks is considered preterm, and all preterm babies are at risk for health problems. The earlier the birth, the greater the risk.

Preterm birth occurs in about 12 percent of all pregnancies in the United States, often for reasons that are not well understood. That is more than half a million premature babies born every year, or about one every minute.

Prematurity is a significant threat to the health and well-being of newborns and their families, and it's the second leading cause of infant mortality in the U.S. In 2005, the national annual cost (medical, educational, and lost productivity) associated with preterm birth exceeded $26.2 billion. Average first year medical costs, including both inpatient and outpatient care are about 10 times greater for preterm ($32,325) than for term infants ($3,325).

Babies who are born very preterm are at a very high risk for brain problems, breathing problems, digestive problems, and death in the first few days of life. Unfortunately, they also are at risk for problems later in their lives in the form of delayed development and learning problems in school. The earlier in pregnancy a baby is born, the more health problems it is likely to have.

Most premature babies require care in a newborn intensive care unit (NICU), which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants.

About 25 percent of premature births are caused by early induction of labor or c-section due to pregnancy complications or health problems in the mother or the fetus (6). In many of these cases, early delivery is probably the safest approach for mother and baby.

More than 70 percent of premature babies are born between 34 and 36 weeks gestation. These are called late-preterm births. Late-preterm babies account for most of the increase over the last decade in the premature birth rate in this country. These infants have health risks and needs often under-appreciated by clinicians and consumers alike. Yet, the growing body of knowledge illustrates that these infants are at greater risk than full-term infants for neonatal complications, including respiratory distress, temperature instability, hypoglycemia, jaundice and hyperbilirubinemia, inadequate feeding, and infection. The research literature also reveals the potential for both short-and long-term neuro-developmental delay and disability.

Why Does preterm labor occur?

There is no one answer to this question. It is thought there are many factors that can cause preterm labor and birth and some women may experience more than one. Researchers are studying how various factors contribute to the complex problem of premature labor and birth.

Some causes that have been linked with an increased risk for preterm birth are: stress, domestic violence, lack of social support, certain medical problems like high blood pressure, obesity and diabetes, urinary and vaginal infections, smoking, and drug use.

More than half of women who deliver a preterm baby do not have any explainable risk factor.

Three groups of women are at greatest risk of preterm labor and birth:

1. Women who have had a previous preterm birth 2. Women who are pregnant with twins, triplets or more 3. Women with certain uterine or cervical abnormalities

If you have any of these three risk factors, it's especially important for you to know the signs and symptoms of preterm labor and what to do if they occur.

Researchers have also identified these groups that are at increased risk of having a premature baby.

* African-American women * Women younger than 17 and older than 35 * Women who have a low income

Preventing preterm labor and birth

You can help prevent preterm birth by learning the symptoms of preterm labor and following some simple instructions. The first thing to do is to get medical care both before and during pregnancy. If you do have preterm labor, get medical help quickly. This will improve the chances that you and your baby will do well.

Medications sometimes slow or stop labor if they are given early enough. Drugs called corticosteroids, if given 24 hours before birth, can help the baby's lungs and brain mature. This can prevent some of the worst health problems a preterm baby has. Only if a woman receives medical care quickly can drugs be helpful. Knowing what to look for is essential.

Doctors may prescribe treatment with a form of the hormone progesterone to help prevent premature birth in some women who have already had a premature baby.

Symptoms of preterm labor

* Contractions (your abdomen tightens like a fist) every 10 minutes or more often * Change in vaginal discharge (leaking fluid or bleeding from your vagina) * Pelvic pressure-the feeling that your baby is pushing down * Low, dull backache * Cramps that feel like your period * Abdominal cramps with or without diarrhea

If you start to have any of these symptoms between 20 weeks and 37 weeks of pregnancy, call your health care provider or go to the hospital right away if you think you are having preterm labor. Your provider may tell you to:

* Come to the office or go to the hospital for evaluation. * Stop what you are doing and rest on your left side for one hour. * Drink 2-3 glasses of water or juice (not coffee or soda).

If the symptoms get worse, or don't go away after one hour, call your health care provider again or go to the hospital. If the symptoms go away, take it easy for the rest of the day. If the symptoms stop but come back, call your health care provider again or go to the hospital.

When you call your provider, be sure to tell the person on the phone that you are concerned about the possibility of preterm labor. The only way your provider can know if preterm labor is starting is by doing an internal examination of your cervix (the bottom of your uterus). If your cervix is opening up (dilating), preterm labor could be beginning.

You and your health care provider are a team, working together to have a healthy pregnancy and healthy baby. Your team works best when both of you participate fully, so your knowledge about preterm labor can be essential in helping to prevent a preterm birth. Talk to your health care provider about all of this, and be sure to keep all of your prenatal care appointments. Preterm birth is one of the complications of pregnancy that health care providers are working hard to eliminate. Your participation in this effort is just as important as theirs!

Ask your legislators to support the PREEMIE Act (expected to be introduced in spring 2011), which reauthorizes P.L. 109-450 and expands research, education and intervention activities related to reducing preterm birth.

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